Randomized trial of conventional transseptal needle versus radiofrequency energy needle puncture for left atrial access (the TRAVERSE-LA study).

BackgroundTransseptal puncture is a critical step in achieving left atrial (LA) access for a variety of cardiac procedures. Although the mechanical Brockenbrough needle has historically been used for this procedure, a needle employing radiofrequency (RF) energy has more recently been approved for clinical use. We sought to investigate the comparative effectiveness of an RF versus conventional needle for transseptal LA access.Methods and resultsIn this prospective, single-blinded, controlled trial, 72 patients were randomized in a 1:1 fashion to an RF versus conventional (BRK-1) transseptal needle. In an intention-to-treat analysis, the primary outcome was time required for transseptal LA access. Secondary outcomes included failure of the assigned needle, visible plastic dilator shavings from needle introduction, and any procedural complication. The median transseptal puncture time was 68% shorter using the RF needle compared with the conventional needle (2.3 minutes [interquartile range {IQR}, 1.7 to 3.8 minutes] versus 7.3 minutes [IQR, 2.7 to 14.1 minutes], P = 0.005). Failure to achieve transseptal LA access with the assigned needle was less common using the RF versus conventional needle (0/36 [0%] versus 10/36 [27.8%], P < 0.001). Plastic shavings were grossly visible after needle advancement through the dilator and sheath in 0 (0%) RF needle cases and 12 (33.3%) conventional needle cases (P < 0.001). There were no differences in procedural complications (1/36 [2.8%] versus 1/36 [2.8%]).ConclusionsUse of an RF needle resulted in shorter time to transseptal LA access, less failure in achieving transseptal LA access, and fewer visible plastic shavings

Symposium Introduction: The Myth of Moral Justice: Why Our Legal System Fails to Do What\u27s Right

I wrote The Myth ofMoral justice,\u27 primarily, as a moral critique of the legal system. In examining the rituals and practices of the law under moral criteria-its obsessive focus on zero-sum contests, its dedication to cold rules and procedural technicalities over human emotion, its failure to acknowledge the spiritual pain of those who come before it, its inability to create an atmosphere where apologies, reconciliation, and the restoring of moral balance to relationships is possible, its preference for judicial economy over truth, its privileging of secrets and indifference to lies, and its failure to promote an atmosphere of mutual caring and connection by not imposing a duty to rescue-the book is an indictment of the legal system for smugly believing that the correct legal result is necessarily consistent with the right moral outcome

Acquiring Procedural Knowledge of a Technology Interface: Introduction to this Special Issue.

Guidelines and models for procedural instructions can be supported by three types of research. Careful analytical studies of collections of instructions can help to identify, describe, and evaluate strategies that writers and designers apply. Empirical studies measure the effects of document variables on the performance of users, thus offering evidence, contraevidence, or refinements for existing guidelines. Theoretical studies, finally, aim to describe and explain the behavior of readers of instructions. To designers and writers, they provide a deeper insight in the underlying cognitive processes that determine success or failure of their work. This special issue offers research articles in all three categories

Electoral Due Process

Elections and their aftermath are matters left to the states by the U.S. Constitution. But the Supreme Court has made clear that the right to vote is federally protected, and fiercely so. When an election failure takes place and deprives citizens of their votes, challengers must resort to state law remedies. Many states have procedural requirements for election challenges that are stringent to the point of being prohibitive. This Note argues that the due process concerns raised by these burdensome state procedures are amplified by their voting rights context. Where a voter must take to the courts to vindicate her right to vote, she should not be further deprived by an unfair process. Federal courts hearing cases about unfair election-challenge procedures have been reluctant to interfere and are thus overly deferential to the states. This Note offers a new approach for “electoral due process” claims—an approach that is properly preservative of voters’ substantive rights and their rights to a fair hearing

Legitimacy and procedural justice in prisons

All social situations are ‘ordered’ in some way, comprising a constantly changing set of relationships that establish the structure within which human action occurs. In many circumstances this order is hidden, even ephemeral; we are barely aware of its presence. But this is not the case in prisons. Social order in prison is in many ways highly visible: it is established and managed by the omnipresent rules that govern prison life. In large part these rules are oriented toward reproducing the extant regime. They lay down apparently strict criteria for what constitutes order and what is to be done if it is breached. But what is meant by order in prison? Most socia

The FENET plate/shell fabrication procedural benchmark and 'round robin' exercise

Plate and shell construction is common across many industrial sectors and covers components and structures that range from the relatively unimportant to safety-critical. The details used in plate/shell structures, in any industry sector, are no doubt a reflection of tradition, as well as market forces and regulation. As a result, for example, full penetration butt-welds will be more common in the nuclear industry, while fillet weld details will be more common in many 'every-day' fabricated structures, ranging from lamp posts to 'bin' lorries. As finite element technology has moved from the so-called 'right-first-time' sectors into general industry, today's powerful analysis and simulation technology is being adopted by more and more organisations, including SMEs, which generally do not have an 'analysis tradition'. In addition, coverage of the assumptions inherent in shell theory generally falls into the postgraduate educational domain. The staffing challenges facing SMEs in particular in this area are therefore significant. Furthermore, it is also argued that many of the details commonly found in fabricated plate/shell structures are often not subjected to widely recognised and commonly accepted cross-industry analysis procedures. The procedural benchmarks and 'round-robin' exercise, detailed herein, were seen as an excellent opportunity to examine such practice and to observe resulting educational and quality assurance related issues

Leverage and Alcohol Addiction

This paper confronts the question of whether messages can be diluted or even contradicted by the format in which they are delivered through a textual analysis of the TNT procedural drama Leverage, examining the portrayal of alcoholism in the program. The procedural drama, which often focuses on figures in law and order occupations, is characterized by close-ended episodes that often feature happy endings. Alcohol addiction has been a staple of many television programs, but these programs were mostly comedies or serial dramas. Leverage, a procedural drama with a light touch, is a modern day Robin Hood tale focused on five thieves led by an alcoholic protagonist. This paper finds that main character displays the expected negative effects of alcohol addiction but also displays positive qualities not often seen when the character is sober. The paper also examines the reactions of the protagonist’s closest colleagues to his addiction, and finds that these reactions, while prominent in the program’s first two seasons, are treated inconsistently in later seasons. The inconsistent treatment of this alcoholism in later seasons, the fantastical and often humorous nature of the program, and the procedural expectation of positive resolution to conflicts begun at the beginning of an episode often undercuts the program’s message about the dangers of alcoholism. This paper briefly contrasts the portrayal of substance abuse addiction in House, M.D., another program characterized by close-ended episodes and happy endings, with Leverage’s depiction of alcoholism. Leverage’s relative failure to accurately depict alcoholism raises questions about whether the procedural drama is the appropriate vehicle for portraying serious internal issues such as addiction